Background: This study aimed to determine the baseline demographics, health status, and drug use profiles of current and former substance-using older adults in Vancouver’s Downtown Eastside. Methods: Data were derived from two U.S. National Institutes of Health-funded cohort studies of current and former illegal drug users in Vancouver’s Downtown Eastside. We used logistic regression of cross-sectional data obtained between June and November 2008 to calculate odds ratios and identify factors that were more commonly associated with cohort members being older adults (greater than or equal to age 50). Results: 214 subjects (25%) were greater than or equal to age 50 upon study enrollment. Females (Adjusted Odds Ratio [AOR]: 0.50; 95% CI: 0.34–0.75) and individuals who reported Aboriginal ancestry (AOR: 0.49; 95% CI: 0.33–0.72) were less likely to be in the older cohort. Individuals with higher income (AOR: 2.07; 95% CI: 1.16–3.68 per $1,000), and those with a regular place to stay were more likely to be in older cohort (AOR: 3.39; 95% CI: 1.90–6.06). Older participants accessed family physicians more frequently (OR: 1.47; 95% CI: 1.01 – 2.16) and were more likely to be actively taking (OR: 3.34; 95% CI 1.71–6.55) or have taken (OR 3.21; 95% CI 1.58–6.53) HIV antiretroviral therapy. There were no differences between groups in regard to injection drug use status or daily alcohol intake. Conclusions: Older current and former illegal drug users in a major inner city Canadian centre have different demographic, health-care, and drug utilization profiles. Further studies in this population are warranted.